Most psychiatrists of a certain age possess a luridly pink slim volume known to them simply as ‘Fish’. Frank Fish's first edition is now 40 years old; the second edition, prepared by Max Hamilton, first appeared in 1974 and was last printed in 1985. Does a revised third edition have anything to offer a new generation of psychiatrists?
It has certainly managed to keep some of the main strengths of the original. The vivid clinical descriptions capture something of the strangeness that abnormal thoughts and experiences must have for those who suffer them. This should be helpful to exam-weary MRCPsych candidates, and their supervisors, in demonstrating that the systematic assessment of mental symptoms is both fascinating and rewarding. The chapters on disorders of emotion, disorders of the experience of self and (unsurprisingly in view of the senior author's interests) on personality disorders are up-to-date, well referenced and provide lucid summaries both of new evidence and of areas of persisting controversy (such as the status of borderline personality disorder).
Some of the other chapters have not been updated as extensively: all but one of the references in the chapter on classification, for example, are from before 2000. This chapter would also have benefited from more critical discussion of the currently used classificatory systems and the challenges for DSM–V and ICD–11. Although symptoms are lucidly described throughout the book, there is little guidance on how to elicit them and the cultural dimension is all but ignored. This is particularly striking in the appendix on ‘psychiatric syndromes’ which has a single paragraph on ‘culture-bound disorders’. Post-traumatic stress disorder (PTSD) is omitted entirely, which is particularly surprising given the vivid and varied range of psychopathology with which PTSD victims can present. The appendix on ‘defences and distortions’ provides clear, exam-friendly definitions but fails to place them in the context of the psychodynamic and cognitive frameworks in which they belong.
Overall, the authors have made a brave, if doomed, attempt at achieving the irreconcilable aims of preserving the character of a book which is the product of its (now quite distant) time while also writing something of practical use for today's psychiatrists.
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